Of running shoes and vitamin supplements

Twice a year, Health Quest presents “Better than Chocolate,” a women-only fund-raising gala. Now in its fifth year, the event attracts hundreds of women, who on July 21 were treated to a buffet dinner under a large tent with a view of the river at theGrandviewinPoughkeepsie. Presentations followed in the air-conditioned ballroom.

Motivational speaker Helen Rothberg didn’t discuss health. Kelly O’Toole, a physical therapist at Vassar Brothers Medical Center, said in her talk, “Putting Your Best Foot Forward,” that walking or running three to five times a week conferred obvious health benefits such as decreasing heart rate and blood pressure and increasing lung and blood volume. Dr. Sharagim Kemp, a primary-care and osteopathic doctor practicing atNorthernDutchessHospital, discussed vitamin and mineral supplements.

The Health Quest marketing department clearly understands that the best way to educate people about their health is to pamper them with sweets. Plates of homemade cookies were on each table, and the evening ended with servings of chocolate.

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Feet forward

To get the maximum benefit and prevent injury while running, O’Toole recommended a ten-minute warm up to make the muscles more efficient and to reduce lactic acid in the body. The warm-up should be dynamic, such as a vigorous bout of calisthenics involving the whole body.

The work-out itself, be it running a mile or a quarter-mile, should be within the body’s tolerance. Each week the work-out should be increased by 20 to 30 minutes as the body gets stronger, O’Toole said. Afterwards, O’Toole recommended five to ten minutes of stretching to cool the body down, to prevent soreness, the pooling of blood in the legs, and possible injury.

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Feet provide mobility as well as stability, so wearing the right shoes is critical. The most important part of the foot is the arch. Flat-footed people, who have wider feet, are susceptible to knee pain, while people with high arches — they have narrower feet — are prone to ankle sprains. Flat-footed people require “a more solid sneaker with inside support,” or what’s called a “motion control shoe,” O’Toole said. Those with high arches need a shoe that offers more support on the outside of the shoe, to decrease the stretch of the ankle (a “cushion shoe,” in shoe-store parlance).

Covering 350 to 500 miles of running — usually the mileage covered in a year if you’re working out several times a week — will wear out a pair of sneakers. Once they lose their tread, you definitely need a new pair. With so many athletic shoes on the market, finding the right pair can be overwhelming. Start with purchasing the shoe that’s designed for your particular workout.

“Your feet absorb the shock of one to two times your body weight if you’re walking and from three to four times of your weight if you’re running,” O’Toole explained. For walking, you need a shoe that’s “more flexible through the ball of the foot but more rigid than a running shoe, which should have more cushioning in the heel, because that’s where you land,” she said. If you are using the same shoe for walking and running, O’Toole recommended running shoes, which provide better support.

O’Toole suggested a “shoe test” in the store. Hold the heel in one hand and the toe in the other hand, and bend the shoe to see where it breaks. It should be near the toes, not the middle.

O’Toole recommended against some types of shoes on the market for athletic use. Rocker bottoms, for example, which have a flexed sole, forcing the calves and ankles to push the legs forward. The cushioned heel offers less stability. Sketchers Shape-ups also distort the body posture. “If you have pains in the shin or in your lower back, stop wearing them, O’Toole said.

Skeleton shoes, marketed as the nearest thing to walking or running with bare feet, are also not the best, since feet “need support” (which is why O’Toole said running in bare foot wasn’t a good idea). “These shoes provide no arch support, nor support in the heel, which makes you more susceptible to injury,” she said.

Dealing with injuries

Common foot injuries include plantar fasciitis, which is overstretching of the muscle in the foot, resulting in micro-tears. It’s caused mostly by walking or running on a hard surface. Pain under the heel is another problem that can develop; the first step out of bed in the morning can be agonizing. The pain can be mitigated by “writing the alphabet in the air with your foot before you get out of bed, or stretching your calf.” Walking on a soft surface, such as a dirt road, also helps. Shin splints are caused by flat feet, wearing the wrong kind of shoes and a lack of flexibility. O’Toole suggested adding or extending your warm-up to lessen the pain, or — in severe cases — switching to a low-impact sport such as biking or swimming.

To treat pain from an acute injury — a sudden sharp trauma — use ice, while a chronic condition — a nagging pain that comes and goes, accompanied by soreness or dullness — is best treated with heat. Side cramps, caused by too-shallow breathing or eating or drinking too soon, can be avoided by starting your work-out at a slow pace. Muscle cramps are a sign of dehydration; if you loss more than two points between the start and end of your workout, don’t rejoice; it means you’re dehydrated.

Is it good to eat before you go for your walk or run? O’Toole recommended a light meal one to two hours prior, preferably consisting of protein, such as a banana with peanut butter. An hour after your workout, eat a full meal, such as eggs and toast. She said a person burns the same amount of calories on an empty stomach, and perhaps even less. Eating something beforehand is wise.

In general, “introduce exercise into your life in a slow and gradual way,” she concluded, noting that the chocolate extravaganza at the end of the event wasn’t entirely out of keeping with the theme of personal health: dark chocolate is included in the top 25 healthiest foods listed on www.prevention.com, along with eggs, yogurt, fat-free milk and nuts.

Supplements discussed

Dr. Sharagim Kemp’s talk, “Supplements, Miracle or Myth?” addressed a topic that’s on almost everyone’s mind. Does one really need that vitamin or mineral supplement? The vitamin industry is huge, representing close to $20 billion in sales. Half of all American adults (mostly women) take at least one supplement, with some people taking as many as ten to 15 a day. When Kemp asks her patients what supplements they’re taking, “it’s not uncommon for the person to bring in grocery bags filled with 40 supplements.” Before investing in multiple vitamins, minerals or herbal extracts, Kemp advised a simple blood test to determine if there is a deficiency.

Kemp focused on several of the most popular supplements: Vitamin D, Vitamin B-12, calcium and the pterostilbene supplement.

Vitamin D is a hot topic these days, partly because it’s so important to health: D is crucial for the joints, bones, and immune system, and it’s believed to play a role in cancer prevention. (Kemp noted that studies of breast cancer patients several years ago revealed that many of the women had a Vitamin D deficiency). One source of Vitamin D is the sun — recommended exposure is at least 20 minutes a day — and our indoor culture may explain why many people have a deficiency. (Also, as people age their skin is less able to absorb the vitamin.) Other sources are from diary, fish and egg yolks. People who don’t eat dairy are also at risk of a deficiency.

Kemp said a deficiency doesn’t usually result in obvious symptoms; fatigue and joint pain can be symptomatic, but not necessarily, since they could be caused by other problems as well. A blood test is the surest way to determine if there is a problem.

Generally, taking a supplement of from 800 to 1000 IU a day is enough for most people. While some people with a severe deficiency might take 50,000 units a week for twelve weeks, Kemp said she wouldn’t recommend this. “I don’t believe in mega doses,” she said. “You can overdose.”

The powerhouse vitamin

Vitamin B-12 is the “powerhouse” vitamin, Kemp said, one of her favorites. It “plays a role in energy, mood, libido, nerves, joints, muscles. If there’s a deficiency, there’s severe consequences,” such as pernicious anemia, an illness caused by the gut’s inability to absorb food. One of the nice features of Vitamin B-12 is that you can’t take too much, since it’s water soluble and unlike Vitamin D can be stored, said Kemp.

Kemp recalled the case of a 30-year-old woman she encountered while completing her residency. The woman had successfully run her own business but had lost it after falling ill and suffering from dementia. She was found to be severely deficient in Vitamin B-12. After a few weeks of injections she was able to get her life back and now is a Fortune 500 CEO.

Injections are only for severe cases; normally, one takes Vitamin B-12 in tablet form, anywhere from 100 to 1000 units a day. In the diet, Vitamin B-12 is obtained from fish and shellfish, meat (especially liver), dairy and eggs.

Calcium is another much-discussed supplement. By now most people are aware that a deficiency can cause osteoporosis, the thinning of the bones that causes stooped posture and increased risk of fractures. “Every cell in the body has calcium, and the source is the bones,” said Kemp. The problem is that the bones are fully developed by age 30, and thereafter the body starts losing bone mass. “You need a calcium supplement to help win the battle,” said Kemp. Food sources include dairy, orange juice, fish and almonds.

Calcium got a bad rap when a recent study revealed that calcium supplements are bad for you. The issue is that there are two types of calcium supplements, and only one type — calcium citrate — is good for you, Kemp noted. (The type to be avoided is calcium carbonate.) “If you don’t take it correctly, it doesn’t work,” she said. “It needs to be absorbed by the body.” She recommends 1200 IU daily, taken in divided doses, to enhance absorption.

Kemp emphasized that supplements “should be an adjunct to a healthy diet and daily exercise,” and that “more is not necessarily better.” A member of the audience asked whether taking a multivitamin was a good idea. “It’s hit or miss,” Kemp responded. “If you’re eating a well-balanced diet, a multivitamin is unnecessary.” For the average person, Vitamin D, Vitamin B-12, and calcium supplements are the ones that she recommends.

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